Psychology of Aging
This is a major part of the way people age. Social and individual assumptions about age and its consequences can lock people into a series of self-fulfilling expectations. The following listings are taken from an excellent self-help book :

Fries, James F. Aging Well. Addison Wesley, Reading (1989)
They succinctly review some of the issues that are in play, whether they be inherent in the aging process or aspects of the cultural overlay.

'The Disease of Stereotypes'
Dr. Fries puts attention on stereotypical assumptions about the elderly
as they are often implicated in the complex of social and familial interactions that can re-enforce illness. He suggests viewing these stereotypes in a different way such that the resulting attitudes and responses become more life affirming.

Crotchety, irascible --- Wisdom and counsel
Opinionated, impossible, rigid --- Learns actively
Not open to new ideas --- Seeks new inputs
Repeats the same old stories --- Has huge store of accumulated memories
Overtly critical of other generations --- Has unique perspectives and experiences
Lives in the past --- Seeks new experience

Social

Needs to be patronized --- Empathic and helpful
All old people are about the same --- Rich network of good friends
Uses up family resources --- Volunteers constructive efforts
Requires pseudodeferences --- Seeks and enjoys activities
Poses an economic threat --- Relative affluence
Aged individuals are marking time to death --- Looks forward and plans

In his excellent book, Dr. Fries draws some general conclusions which
lead to some clear and practical insights. To again quote from Aging
Well:

Avoid Learned Helplessness. Consider setbacks as accidental, isolated events that will be over soon.

Develop Self-efficacy. Recognize that your choices can change your future, and exercise your right to choose.

Choose the right coping strategies. With personal crises, work to see a good side to them, and cope by using humor and altruism.

Use the Life Cycle to your Advantage. Use the positive attributes of age to achieve the goals of age.

Some basic principles of aging well

MAINTAIN INDEPENDENCE

MODERATE HABIT

KEEP ACTIVE

BE ENTHUSIASTIC

BE POSITIVE

BE INDIVIDUAL

Spiritual and Socio-Economic Issues
There are not only biological and psychological factors involved in aging. Sociological, economic and spiritual issues also play a profound role, but an adequate discussion of this complex of factors is beyond the scope of this course (or the skill of this author). A couple of brief points must be made however. Age is not a disease. Death is not an evil to be avoided at all costs. Our culture has developed some distorted perceptions about old age, seeing it as the undesirable mirror image of youth. This blinkered perception ignores the incredible value of wisdom and experience, denying our elders a say or seeing their contribution as being desirable. Our whole culture is suffering as a result. We are dealing with spiritual issues here. There needs to be an affirmation of aging and death, seeing it as the rite of passage it is. Much of the illness of elders is either a result of or aggravated by socio/economic issues that are not medical at all. Issues such as isolation and poverty may take the form of cardiovascular disease but won't be helped by Hawthorn. If our culture is going to evolve into a `kinder gentler' one, then attention must be given to these thorny questions.

Toning and Nurturing Health in Elders
A basic premise of this course is that phytotherapy can nurture health and not simply treat illness. This strength of this approach lies in the use of tonics and gentle effect or remedies, using the stronger effectors only where absolutely necessary. This is also the basis for herbal treatment for elders, thus everything covered in the course so far has relevance to the treatment of the individual concerned. Perhaps the most outstanding contribution that herbs can make to the health care of our elders is through system tonics. Tonics and gentle normalizer remedies not only avoid most side effect complications but offer possibilities for the maintenance of wellness and prevention of many problems associated with aging. Please review the material covering wellness and prevention discussed in the last lesson.

Prescribing Issues Unique to Elders
When considering herbal therapy it is important to acknowledge some of the age related pharmaco-kinetic and pharmaco-dynamic changes that occur. Safe drug or herb prescribing for older patients has to be based upon an understanding of the changes that occur to absorption, distribution and elimination mechanisms in the aging process. Taking such issues into consideration helps avoid many complications. Whilst such concerns are not as important for the phytotherapist, they still exist. A brief review of some of the factors involved for both plant extracts and chemical drugs might be helpful. Pharmacological research suggests that the most important issues to consider are :

`Drug' absorption. For a chemical or plant extract to enter the blood stream when taken by mouth, the absorptive lining of the gastrointestinal tract must be healthy. Medicines must remain in contact with the lining for an adequate amount of time for absorption to occur. There must also be an adequate blood flow to and from the site of absorption. Normal age related changes impact all of these factors. There is a reduction in mucosal surface area, reduction in blood flow to the intestines and changes in secretions.

Plasma binding. Plant constituents are transported via the blood once they have been absorbed from the intestines. The more complex molecules are in a form that is often bound with a blood chemical such as albumin. Such protein bound drugs can compete for binding sites, which in turn may have a profound effect upon availability of medications.

Distribution around the body. With advancing age the proportion of body water and lean body mass decreases whilst body fat increases. This favors the distribution of fat soluble constituents over water soluble.

Elimination. The effect of a medicine is ended by it being eliminated from the body or its being changed into some inactive form. This will involve liver metabolism, kidney function, and elimination at other sites around the body. All of these factors become less efficient with age.

As with children, our elders have special needs and plants address these needs. Whenever possible focus upon the tonics and normalizers. The most relevant remedies are pointed out in each section below. Care must also be given to dosage, because of the range of issues touched upon above. In general a lower dosage is used than for younger adults. For details of the standard pharmaceutical formulae used to convert adult dosage to that appropriate for any particular age, please refer to James Green's Medicine Maker's Handbook, part of the supplemental reading material. The main concern is that of `paradoxical' reactions. It is not unusual for medicines to have an opposite effect to that expected with very elderly people. As an example consider that the tranquilizer valium can have a marked stimulating effect upon the nervous system in some elders. This is an unpredictable response, so careful initially careful observation of a patients response is crucial. Be aware of potential paradoxical responses to herbal medications.

Prevention and Herbal Treatment of Disease

Cardio-Vascular System

The cardio-vascular tonics offer a range of remedies uniquely suited for treating problems of the heart and blood vessels in elders. Whilst they do not have the dramatic, rapid and often life-saving effects of many of the drugs currently used, they have a definite advantage when addressing the chronic degenerative conditions often found in this age group. A range of cardio-vascular remedies are appropriate for Elders, each having its distinct area of application. Diuretics can also be especially valuable. Please review these remedies :

A basic premise of this course has been the use of tonics and gentle effect or remedies, using the stronger effectors only where absolutely necessary. As this is also the basis for herbal treatment for elders, suggested treatments outlined in the chapter on cardio-vascular problems are relevant here. An important exception may be the use of Sarothamnus scoparius (Broom) in the treatment of hypotension. It should be avoided as it might prove too strong in some elderly people. Please refer to the following sections :

More than with any other age group it is essential to avoid the inappropriate use of cardiac glycoside containing herbs. Because of the pharmacodynamic and pharmacokinetic changes discussed above, it is all too easy to build up toxic levels of these chemicals. If such support of heart function is needed, it is safest to use the glycosides in a standardized form to ensure dosage is correct. This is almost impossible with the leaf of Foxglove, thus pointing to the value of pharmaceutical preparations of the digitalis glycosides. These are only obtainable via prescription. Please refer to the section on the Cardio-vascular system for a discussion of cardio-active and cardio-tonic remedies. Such potent treatment is not always necessary and, more importantly, not the only option. Remember the cardio-tonic remedies such as Crataegus spp. (Hawthorn), the best known and possibly the most valuable tonic remedy for the cardiovascular system found in the plant kingdom.

A brief review of Crataegus might be helpful, bearing in mind that this invaluable heart remedy does not contain cardiac glycosides. Crataegus spp. can be considered a specific remedy in many cardio-vascular disease. A tonic in the true sense, the therapeutic benefits are only gained when a whole plant preparation is used. When the isolated constituents were tested separately in the laboratory, their individual effects were insignificant, whilst the whole plant has unique and valuable properties. A mulit-center double blind clinical trial done in 1981 demonstrated marked improvement of heart function in patients with reduced cardiac output. Following a four year study commissioned by the German Federal Ministry of Health, Crataegus spp. has gained full recognition as a heart remedy in Europe. The monograph concludes that the herb has these properties :

it is positively inotropic,

it is positively chronotropic & dromotropic

it increases coronary and myocardial circulation, through a dilation of the coronary arteries.

The Ministry concluded that its main clinical applications are in the long-term treatment of `loss of cardiac function', any situation where there is a subjective feelings of congestion and `oppression' in the heart region, mild arrhythmia's and especially for conditions of the aging heart that do not warrant the use of Foxglove. Most significantly is the finding that no contra-indications or side effects were noted at all. Research suggests that much of its observable effects can be explained by the improvement in coronary circulation. It dilates the coronary arteries, relieving cardiac hypoxemia, thus reducing the likelihood of anginal attacks and relieves its symptoms. The herb thus directly effects the cells of the heart muscle, enhancing both activity and nutrition.

Whilst working in conservation and lecturing in ecology and the eco-crisis for the University of Wales, David Hoffman became convinced that to heal the world, to embrace planetary wholeness and responsibility for it......more

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